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IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence CenterUniversity of Regensburg Medical CenterRegensburg, Germany
eHCC
eHealth Week 2007 – KIS Workshop
Thurday, 19 April 2007, Berlin Germany
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
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� Rudimentary, inconsistentElectronic Healthcare Record
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
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�
HL7 v3DICOM
IHEISO/IEEE 11073XML
HL7 v3DICOMIHEISO/IEEE 11073XML
Specialised Electronic
Patient Record
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Electronic Health
Record
“e-health” – Interaction and integration path
Physicians‘s office
SpecialistsClinic
Phamacies Health insurance
E
PA
KIS
...
EKG Ultra-
schall
Laboratories,
nursing etc.
LIS
PoC
POC
T
1-A
Pharmacy
IC
U
Intensive care
Respi
ratorAgent
PDMS
HL7 / XML
HL7 / XML
e-Prescription
ManagerAgent
Monitor
Pumpe
......
Radiology
e- Concultation
11073 / VITAL
PoC ...
Automat
Automat
Laboratory
RIS
MR
Röntgen
DICOMCT
...
Haus / mobil
�?
e-doctor‘sreport
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
CEN ISO/IEEE CEN ISO/IEEE 11073.5xxxx11073.5xxxx Internetworking StandardsInternetworking Standards
CEN ISO/IEEE 11073 StandardCEN ISO/IEEE 11073 Standard
Patient monitor /
Device manager
E.g. infusion pump,
respirator,
pulse oximeter
Use of different transmission technologies (wired, IR, radio)
Examples: transition to TCP/IP-LAN,
access points for wireless and IR devices:
11073
AgentDevice
11073ManagerSystem
11073.5xxxxInternetworking
11073.3xxxx
Transport A
11073.3xxxx
Transport B
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
CEN ISO/IEEE 11073.6xxxx Application GatewaysCEN ISO/IEEE 11073.6xxxx Application Gateways
CEN ISO/IEEE 11073 StandardCEN ISO/IEEE 11073 Standard
Interoperability between application protocols
Example: CEN ISO/IEEE 11073.60101 Application Gateway HL7, Observation
Reporting Interface: enables interoperability with HIS.
(11073 Coding scheme has been registered as HL7 Coding Scheme
in 2002.)
CEN SSS-HIDE (2001) : Health Informatics-Strategies for harmonization and integration of device-
level and enterprise-wide methodologies for communication as applied to HL7, LOINC and ENV 13734)
non-1107311073System
(Agent/Manager)
Application11073.6xxxx Gateway
(evtl. 11073.5 Internetworking)
11073.3xxxx
Transport
11073.3xxxx
Transport
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
CEN ISO/IEEE 11073 StandardCEN ISO/IEEE 11073 Standard
� integrates IEEE 1073 work („Medical Information Bus“, since 1983 ), CEN TC 251
(ENV 13734 „VITAL“, ENV 13735 „INTERMED“, since 1993), NCCLS /CLSI (POCT1-A),
HL7 (Devices SIG, since 2005), Bluetooth WG on „Medical Device Profile“, IHE etc.
� enables functional and semantic ad-hoc interoperability through:
- object-oriented modeling of function and application area ("Domain Information
Model“: devices, functionalities, measurement data, calibrations, alert information,
remote control, patient information, interfaces)
- standardized codes for naming all information elements: "Nomenclature" and "Data
Dictionary“
- optional components and profiles for different communication needs and device
classes („Application Profiles“/ „Device Specializations“).
� conceptually based on ISO Systems Management (ISO/IEC 10040, 10164, 9595 :
Agent/Manager - Service Model)
� considers limited hardware expenditures for „Embedded Systems“ platforms.
� defines transition between network technologies and application protocols (HL7)
CEN ISO/IEEE 11073 Standards Family
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
HCE1 HCE2 HCEn HCEn+1 HCEp
S1,1
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� Personal Health
Record
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Pervasive
ComputingLocation-independent
service provisionTelematics,, Telemedicine
MobileComputingAccessabilityTele-consultation
AutonomicComputing
Self-organisationHealth information
systems
UbiquitousComputing
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Manua
l data
entr
y
Lang
uag
e-b
ased
data
entr
y
Barc
ode
scans
Passiv
e t
ags
Active t
ags
Informatics world (“Bits”)
• Intra- and extra-organisational
information systems (e.g. ERP)
• Local, regional and global
communication networks
(e.g. Internet
Physical world (“Atoms”)
• Human beings
• Means of production
• Products
Human intervention
required
No human intervention
required
Gap between
physical and
informatics world
Data entry
costs
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Body Area Network (BAN):
Body Sensor Units (BSU):data entry and (pre-)processing
comfortable, being „invisibly“ worn
minimal size and weight
Body Central Unit (BCU):personal user interface
management of several BSUs
data concentration, processing, etc.
event recognition and management
wireless connection to external networks (BT, DECT, WLAN, GSM, UMTS,..)
Ad-hoc interoperability���� „(un)plug & play“
EKG
Blutdruck
Temperatur
…Atmung
BT, GSM etc.
Body Central Unit
(BCU)
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
POCCIC/(NCCLS/) CLSI POCT-1A ���� CEN ISO/IEEE 11073.90100
� 1999-2001 developed by an industry consortium with IEEE und HL7 input
� defines two interfaces: - Device Interface (DAP: IEEE 1073, DML: HL7 V2.3 + XML)
- Observation Reporting Interface (ORI: TCP / IP + HL7V.2.3)
Device Interface
Observation Reporting Interface
DAPORI
Test Results,QA/QC Information
Test Results,Ordering Information
Devices,
Docking
Stations
POC Data
Managers
LIS, CDR,
other CIS
Access
PointsNetwork
DML
ObservationReviewer
Device ObservationRecipient
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Smart Microsystems – the other end of the
interoperability chain
� IMEX* IEC standard draft for cross-vendor micro-system interoperability
*German VDE / BMBF IMEX Project: „Implantierbare und extrakorporale modulare Mikrosystemtechnikplattform“
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Requirements for achieving interoperability and harmonisation (1/2)
• Openness, Scalability, Flexibility,
Portability
• Distribution at Internet level
• Standard conformance
• Service-oriented semantic
interoperability
• Consideration of timing aspects of
data and information exchanged
• Lawfulness
• Appropriate security and privacy
services
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Requirements for achieving interoperability and harmonisation (2/2)
• Distribution, Component-orientation (flexibility, scalability)
• Model-driven and service-oriented design
• Separation of platform-independent and platform-specific
modelling → separation of logical and technological views
(portability)
• Specification of reference and domain models at meta-level
• Interoperability at service level (concepts, contexts,
knowledge)
• Unified Process
• Common terminology and ontology (semantic interoperability)
• Advanced security, safety and privacy services
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
En
terp
rise
Vie
w
Info
rma
tion
Vie
w
Com
pu
tationa
l V
iew
En
gin
ee
ring V
iew
Te
chno
log
y V
iew
Business Concepts
Relations Network
Basic Services/Functions
Basic Concepts
Domain n
Domain 2
Domain 1
Component View
Com
ponent
Decom
positio
n
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
The Personal Health Paradigm
Health
Telematics
Biomedical
Engineering
Bioinformatics/Genomics
Telemedicine
Personal Health
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Standards Classification Health Informatics (1/2)
• Architecture standards
- HL7 versions 2.x/3, CORBA, MDA, HISA
• Modelling standards
- UML, CEN 15300: “CEN Report: Framework for formal
modelling of healthcare security policies”
• Communication standards
- CEN 13608: “Security for healthcare communication”,
CEN 13606: “Electronic healthcare record
communication”
• Infrastructure standards
- ISO 17090: “Public key infrastructure”, ETSI TS
101733: “Electronic Signature Formats”
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
• Privacy standards
- ASTM E1987-98: “Standard guide for individual rights regarding health
information”, CEN 13729: “Secure user identification - Strong
authentication using microprocessor cards”; ISO/IEC PDTS
Pseudonymisation Practices for the Protection of Personal Health
Information and Health Related Services
• Safety standards
- CEN 13694: “CEN Report: Safety and security related software quality
standards for healthcare”; ISO/DTS 25238 Classification of Safety Risks
• Terminology and ontology standards
- UMLS, SNOMED
• Identifier and identification schemes
- LOINC, ASTM E1714-00: “Standard guide for properties of a Universal
Healthcare Identifier”
Standards Classification Health Informatics (2/2)
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Personal Health Characteristics
Personalization of • Process design• Workflow management• Concept representation• Concept aggregation• Terminology/Ontology• Result compilation
• Diagnostic methods• Therapeutic means
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Conclusions (1/3)� Health telematics and telemedicine necessitate requirements on interoperability
between clinical and health policy processes as well as stakeholders.� “Personal Care“ and personal ubiquitous health services extend “e-Health” and
require the integration of personal, body worn or implanted mobile systems as part of the health telematics infrastructure.
� Mobile Body Area Networks are an essential platform for future personal ubiquitous health services.
� Interoperability implies different concepts ranging from functional interoperabilityup to the comprehensive semantic interoperability.
� For essential function areas, international standards are available or establishedresp.
� Interoperability of personal mobile systems includes all 7 layers of the ISO / OSIReference Model including terminology, knowledge concepts, coding aspects, etc.
� The CEN ISO/ IEEE 11073 standard family contains corresponding profiles for all 7 ISO/OSI layers, which can be used for personal systems too.
� Micro-systems are essential components for such structures, requiring the extension of existing approaches and interoperability chains.
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Conclusions (2/3)
• Crucial demand for simplified, standardised methods to access
healthcare information and services � making healthcare safe and
available to all
• Appropriate standards for healthcare information and systems �
cornerstone to achieving a reasonable healthcare infrastructure
• Many health informatics standards exist, emerge, or are under
adaptation to meet requirements
• Obstacles: existence is not well known, not used enough,
interoperability often not proven, and some conflicts
• Conformance statements needed; testing and certification must be
performed � achieving interoperability is a considerable challenge
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
• Real need for formal and informal co-ordination of standardisation efforts
- to leverage the synergy of the various efforts, - to harmonise vocabularies, - to enable interoperability, and - to promote consistent testing and certification programs across and within
organisations
• Develop tools and prototypes to promote consistent definitions and artefact reuse, and facilitate interoperability for healthcare systems
• Spread acceptance of management of health information standards across the whole eHealth community
• Achieve full and appropriate integration into all information flows• Privilege management infrastructure standard addresses
complexities of RBAC and management of user privileges• Effort will establish consistent means for protecting personal health
information within and across enterprises
Conclusions (2/3)
IT Support for a Patient-oriented Care
Bernd Blobel
eHealth Competence Center
University of Regensburg Medical Center
KIS Workshop
Thursday, 19 April 2007, Berlin GermanyeHCC
Contact:
Bernd Blobel Ph.D., Associate ProfessorHead, eHealth Competence CenterUniversity of Regensburg Medical CenterFranz-Josef-Strauss-Allee 1193053 RegensburgGermany
Email: [email protected]@ehealth-cc.de
Tel.: +49-941-944 6769Fax : +49-941-944 6766
Questions?